The announcement this week that agreement has been reached to pass the first significant piece of national climate policy has been a good news story for the government and generated a modest sense of victory among climate action advocates.

But among all the relief, enthusiasm and general disbelief that the Australian parliament could actually agree on something so sensible as a committment to reducing emissions, it is useful to remind ourselves why we are doing this, what the end goal is, and where we are on the journey so far.

The point of it all, after all, is to reduce emissions, not just arrest emissions growth – and presumably that would be one of the criteria in evaluating the effectiveness of the policy. Also that those emissions reductions are sustained over time, and ultimately lead to zero emissions – given that, according to the science, the Earth is already too hot, and we need to not only cut emissions to zero, we also need to draw down legacy emissions in the atmosphere if we wish to stabilise the climate.

Ahh, the science, you sigh. The pesky scientists! When will they be happy?! Don’t they know how difficult it is to negotiate a politically acceptable deal? Well, yes, but in the realm of physics and atmospheric chemistry, Abbott doesn’t matter, Monkton doesn’t matter, and Andrew Bolt doesn’t matter – atmospheric CO2 just continues to rise, the oceans more acidic and the ice sheets melt, regardless of how politically inconvenient it might be.

And what do the scientists say? Well, Melbourne will have the opportunity to find out this week, with visiting climate experts Hans Schnellnhuber and Malte Meinhausen in town from the Potsdam Institute in Germany. The occasion is “Four Degrees’, a conference hosted by Melbourne University, so named because that’s the lower end of the anticipated rise in global average temperature by the end of this century if we continue on the business as usual path.

A climate that is an average of four degrees hotter is completely unprecedented in human history, and if Schellnhuber’s advice from 2009 is anything to go on – humankind will be “toast” at that sort of rise. The Earth has not been four degrees warmer for the last ten million years, and humans were not around then to test their response to it.[i] But the predictions are that we won’t go so well – Professor Kevin Anderson, director of the Tyndall Centre for Climate Change in the UK, believes only around 10 per cent of the planet’s population – around half a billion people – will survive if global temperatures rise by 4C.

Anderson was fairly frank back in 2009: “For humanity it’s a matter of life or death,” he said. “We will not make all human beings extinct as a few people with the right sort of resources may put themselves in the right parts of the world and survive. But I think it’s extremely unlikely that we wouldn’t have mass death at 4C. If you have got a population of nine billion by 2050 and you hit 4C, 5C or 6C, you might have half a billion people surviving.”[ii]

Meinhausen and others have calculated what volume of greenhouse gas emissions we can pump into the atmosphere between now and 2050 to have a reasonable chance of keeping warming lower than 2°C (above pre-industrial levels). We can only emit 1000 billion tonnes of carbon dioxide (CO2) between the years 2000 and 2050. Trouble is, we’ve emitted a third of that in just nine years.[iii]

If we were to share the total remaining carbon budget equally throughout the world on a per capita basis, Australia would exhaust its budget (as one of the highest per capita emitters in the world) in just seven years.

Our commitment in Australia remains (for now) a 5% reduction in 2020, and 80% by 2050. But the science says, if we were to deal with this in an equitable manner, we need to get to zero in less than a decade.

Just to give some perspective.

So while the carbon price package is welcome, and quite possibly is the best we could get in the current political environment. But let’s not kid ourselves that it is bold, generous, or responsive to the science.

And whose fault is that? Well, that’s just the problem, Australians are all too ready to point the finger elsewhere (at the government, at business, or anywhere – else) and say “they” failed; “they” should have done something else; “they” should have shown some leadership. All that might be true, but parliamentarians will only respond when their constituents demand something of them, and so far, most people in Australia are content to bury their heads in the sand, and pretend it’s not happening, or simply distract themselves by wishing the growth economy back to health, as if continuous economic growth was possible on the back of the loss of natural capital, in the middle of a mass extinction event, when we have gone well into ecological overshoot and are playing pretend that if we use up natural resources faster than they can be replaced that some magical process will make it all right in the end.

At its core, climate change is a health issue. Around 300,000 people are dying each year from climate change.[iv] Around five million more will die in the coming decade if we fail to act effectively.[v] The bulk of the climate health burden (over 80%) falls on children – that’s right, children, who are powerless to make decisions to increase those emissions that are destroying their health and their future; powerless to say “stop, we choose a different future”.[vi] Children, for whom the health burden is not temporary, but for whom early exposure to disease leaves them with lifelong vulnerabilities. Who face higher exposure to pollution per unit of body weight. Who by virtue of having more future years of life face greater threats over a longer period that the rest of us.

Who will advocate for them?

Despite the declaration in The Lancet in 2009 that “climate change is the biggest threat to global public health of the 21st century”, health professionals have so far failed to respond in ways that are proportionate to risk. Public health experts describe a wearied tolerance from other health colleagues when they hold forth on climate change – as though it were some sort of personal hobby horse whereas others in different parts of the sector are “busy saving lives” and “don’t have time for this sort of indulgence”.

Well, that’s regrettable because climate change will eclipse all other threats to health in the coming decades if we don’t turn our attention to finding solutions to the biggest threat there is. We must of course continue to act on existing disease burdens, as many will be (are being) exacerbated by climate change. But this threat is global, it’s enormous, and until the world seriously turns its attention to dealing with it, climate change will bring unprecedented and dramatic negative impacts on human health.

The good news of course is that there is good news. Many strategies to reduce emissions will also bring health gains. This should be also a major source of attention for health professionals – and a focus of their advocacy for action on climate. Because advocating for action on climate change is possibly the biggest contribution health professionals can make to global public health. The health message is one that, despite the best efforts of some, remains missing from the climate policy story. But the evidence suggests that, when framed as a health issue, climate change is more likely to be perceived in an individual context, and people are more likely to support action for mitigation.

We’ve seen a little bit of political leadership on the issue this week. But we mustn’t imagine that’s enough. The job is much, much bigger than that, and the voice of all health professionals, as respected leaders in society, would be very welcome in keeping this trajectory on track, to denounce those who misrepresent the science, and to call for action as civil society leaders to send the clear message to the rest of the community, from people who have no vested interest, that climate action is urgent, and ultimately, it’s good for health.

In all the to and fro of the current carbon pricing debate here in Australia, one important aspect of the story on climate action is missing.

Why are we acting on climate change? Well, because of the evidence that it poses risks to the global economy, to infrastructure, and to our natural environment. All that is true and makes for a compelling case for action. But at its very core – climate change is a health issue.

It places the safety and wellbeing of our species in jeopardy. Climate change is already responsible for the deaths of more than 300,000 people each year.[1] Five million more deaths are expected during the next decade if no effective action is taken to reduce climate risk.[2] Over 80% of the disease burden attributable to climate change falls on children.[3]

The international medical journal The Lancet outlined the stark facts in 2009: that the effects of climate change from global warming “puts the lives and wellbeing of billions of people at increased risk”.

Climate change presents serious immediate and long term threats to the health and wellbeing of the Australian and global population.

The direct health effects of climate change include deaths, injury, and hospitalisation associated with increasingly frequent and intense bushfires, cyclones, storms and floods and heatwaves.[4] Indirect effects include increases in infectious and vector borne diseases, worsening chronic illness, and health risks from poor water quality and food insecurity.[5]

Health care services in Australia are already experiencing dramatic increases in service demand from climate related events, such as heatwaves and floods.[6],[7] The heatwave that preceded the Black Saturday bushfires in Victoria in 2009 saw a 62% increase in mortality from heat related illnesses and worsening chronic medical conditions. During this five day event, there was a 46% increase in demand for ambulances; an eight-fold increase in heat related presentations to emergency departments; a 2.8 fold increase in cardiac arrests; and a threefold increase in patients dead on arrival.[8]

So there are many compelling reasons to act on climate change from the point of view of reducing health risks. This story is missing however from the policy debate – it is missing in the explanations from our leaders about why we must act, it is missing from the narrative of many advocacy groups who imagine that a threat to polar bears will be sufficient to elicit support for action. This is not proving to be the case.

Health is not only one of the most compelling reasons to act on climate change – its actually one of the reasons most people will feel compelled to act on climate change, because framing climate change as a health issue is one of the ways we can best appeal to people’s individual assessment of risk from climate change. Put in a health context, people are far more inclined to consider climate change as an issue that affects them.

And there are many health gains possible from climate action. Reducing our reliance on energy supply from coal and encouraging shifts in transport away from fossil-fuel-guzzling cars to public transport will reduce air pollution, improve social capital and bring concurrent increases in activity which, in turn, all help reduce obesity, osteoporosis, heart disease and diabetes, not to mention road traffic injuries and deaths.

Shifting away from coal as a fuel source for electricity will improve air quality and reduce related deaths from lung cancer and heart disease. Switching to low emissions and more active transport systems can significantly improve air quality and reduce respiratory disease, as well as cut the incidence of obesity, chronic illness and cardiovascular disease. Changing to a diet with lower meat consumption can cut emissions from livestock production as well reduce heart disease and diabetes.[9]

The economic argument for the health benefits of climate action is also very strong: a recent report from the European Union reveals significant health and economic benefits are associated with strong targets for emissions reductions, with a target of 30% reduction by 2020 expected to deliver health care savings from avoided ill health of €80 billion per year.[10]

Effective action on climate change has the potential to significantly reduce the health costs (both economic and social) we will face in the next decade and the coming century. It’s also an important way to build public support for action [11]. If our political leaders were serious about building public support (and acting in the national interest), they would be talking about addressing “the biggest threat to global health of the 21stcentury”,[12] not talking about compensating polluting industries.

Given the hysteria around the current debate on a carbon tax, it seems timely to republish on the CAHA blog an edited version of this article published in Fairfax’s National Times last year: No need to be afraid of a tax on carbon.

The agreement between The Gillard Government and The Greens that a carbon price is paramount to tackling carbon pollution signalled a restoration of a significant climate policy agenda in Australia. It was well overdue, given the overwhelming recognition that a carbon price is central to effective emissions reductions.

This has been the case since Sir Nicholas Stern’s landmark report in 2006, which identified a carbon price as a key element to cutting emissions. And despite independent MP Bob Katter’s poor opinion of Sir Nicholas (describing him in 2010 as “a lightweight”), Stern remains a pre-eminent expert on the economics of climate change.

Nothing has changed since his report in terms of the need for a carbon price; only the urgency of its application has increased.

Achieving this in Australia, however, has been difficult to date – the Carbon Pollution Reduction Scheme (CPRS) was a miserable attempt at pricing carbon, and its flawed approach (rejected quite rightly by The Greens and others) with inadequate targets, excessive use of offsetting and unnecessary compensation to polluters, has contributed to the discrediting of emissions trading as the preferred option for pricing carbon internationally.

While Opposition Leader Tony Abbott remains vehement in his opposition to new taxes, he doesn’t (yet) appear to understand that his policy of direct investment is just another way of putting a price on carbon. And while Abbott may be opposed to the idea of a specific carbon tax, the allocation of funds to reduce carbon emissions is using revenue collected through taxation.

To argue that we shouldn’t have a carbon price because it will drive up electricity prices is nonsense – electricity prices are already going up and will go up even further without a carbon price, because there is no incentive to invest in energy generation infrastructure while there is uncertainty around a price on carbon. Capital expenditure on power generation in Australia is expected to decline $10 billion over the next five years unless there is a price on carbon.

In terms of actual mechanisms, the most appropriate tool is a carbon tax. Supported by most environmental economists (and others such as Nobel Laureate Joseph Stiglitz and Jeremy Sachs), a carbon tax is already in place in many European jurisdictions where it has reduced emissions while maintaining, even improving in some instances, economic productivity.

Most arguments against a carbon tax incorrectly identify the misplaced allocation of funds as a flaw of the mechanism itself, rather than its faulty implementation. A carbon tax is a way of obtaining revenue (appropriately, by taxing polluters). What is done with that revenue determines what its impact will be on the community, whether it is supporting low income or vulnerable households or supporting the expansion of renewable energy technologies – not the tax itself. Its popular appeal could also be enhanced by reducing other taxes, such as income taxes, while maintaining the pressure on polluters to find ways to cut emissions.

The “anti-tax” position adopted by Abbott is a very simplistic argument. A carbon tax will provide a revenue base that we can use to diversify our economy away from a ”quarry and dump” to potentially manufacturing, operating and exporting renewable energy infrastructure – creating thousands of jobs and bringing wealth to our deprived regional areas.

We are witnessing of course the inevitable squealing from the emissions intensive industries, and re-runs of the “sky is falling” argument by the big polluters. The reality, however, is that ongoing opposition to a price on carbon will mean we better steel ourselves for the “brownouts” that will result, not because of the carbon price, but because we lack one. The failure or unwillingness to invest in new power generation will inevitably lead to considerable economic disruption and societal dysfunction.

But while a carbon price is central, it is only one tool in the suite of policy options that are needed to bring down emissions, help make clean renewable energy cheaper, and discourage polluters from dumping their waste in the atmosphere. We need to move quickly to a suite of policy mechanisms that not only make clean renewable energy competitive with fossil fuels but will also reduce emissions from transport and building stock and agriculture.

To achieve this it is vital that we legislate a carbon price and move on from the argument about a carbon tax versus emissions trading. We must seek the establishment of a national plan to guide Australia’s transition to a low carbon and then zero carbon economy. Other more responsible countries are investing in whole of society transition plans – recognising that transition is inevitable and, carefully managed, it will bring far more positive outcomes than ad hoc adaptation and emergency responses.

We’ve had enough of intermittent commitment to individual policy mechanisms – it is time for a considered framework that will guide our country’s transition to the low and then zero emissions society that promotes and protects our economic, environmental and social wellbeing.

The passing of the flood levy to rebuild Queensland by the Senate today will allow for a new beginning for thousands of people affected by the floods, and go some way to addressing the damage repair bill – estimated as billions of dollars.

This levy will assist in alleviating some of the catastrophic impacts of the floods on the state and on local communities, for whom recovery will take months and years as houses and infrastructure are rebuilt, and lives and businesses pieced back together. It is to be hoped the support of government and community along with relief appeals will make the task of rebuilding easier for affected communities.

But as communities are rebuilt, what preparations are being made to protect them from future damage and risk?

These floods were a sobering reminder of the power and influence of the natural environment on the safety and wellbeing of the community.

But one of the most extraordinary aspects of the recent extreme weather in Australia was not the ferocity and scale of the record breaking events but the absence of any public dialogue about the link between these events and global warming.

The recent floods in Queensland and Victoria have been widely acknowledged as being of epic and unprecedented proportions but little is being said about the human contribution to forces driving these events.

Just as the reports from the devastating bushfires in Victoria in 2009 ignored the contribution of anthropogenic global warming and its subsequent effects on the severity and frequency of extreme weather events, there has been little or no recognition among journalists or political leaders about the links between climate change and the floods that affected hundreds of thousands of people across Australia.That politicians ignore the issue is easier to understand – the Queensland Premier has an election to fight next year and her government has recently endorsed an ongoing to commitment to industries responsible for causing climate change, such as coal.

But the failure of the mainstream media to question this contribution, to seek the advice of experts, or to draw links between these events and global warming in an effort to educate (one the media’s most important roles) the community on this issue is bewildering and alarming. The failure to do so will almost certainly come at considerable future cost to the community. The costs of cleaning up and rebuilding after the floods in Queensland is enormous, and goes well beyond financial and extend to broader economic as well social, psychological, and human health costs.

Given the likelihood that these events will occur again, with one in a hundred year events now occurring every few years (or in the case of St George, every year), and with increasing intensity and frequency, we should be seeing a recognition of this in actions to prevent further catastrophe for populations at risk.

The scientific evidence is extremely clear: continuing to burn fossil fuels for power generation and thus contributing to further global warming places the entire human population at great risk. It places particular populations (e.g. those residing on low lying areas; some coastal communities; those with limited water security) at considerable risk. For too long, too many Australians seem to have adopted the view that climate change is only going to affect poor people, far away. But as evidenced by recent events in Australia, we can now count ourselves as among those populations at great risk. This level of risk has arisen from the global average temperature rise that has already occurred of just 0.8°C.

This level of warming took around 100 years to occur. However we know that, thanks to an inexorable rise in greenhouse gas emissions (up about 10% each decade in Australia), atmospheric CO2 levels have now risen to 390ppm, higher than at any time during human civilisation on Earth. This is considered responsible for increases of global average temperatures of around 0.2°C per decade.

Given there is now demonstrable current catastrophic effects on our local population from less than 1°C rise, it is incredible to witness the failure to acknowledge this risk by those in a position to not only inform the population of this seminal risk, but those who have accepted responsibility to lead our community.

Russian President Medvedev acknowledged the link between extreme weather events and global warming in 2010 when unprecedented soaring temperatures contributed to 56,000 deaths in his country, saying “… what is happening now in our central regions is evidence of this global climate change, because we have never in our history faced such weather conditions in the past.”

The effect of these events on Australian communities is shocking. And it is regrettable that only now will many Australians feel any empathy with the 750,000 recently left homeless in Sri Lanka from flooding and the 20 million displaced in Pakistan in 2009.

Emeritus Professor of Science and Technology at Griffith University in Queensland, Ian Lowe said: “The Queensland floods are another reminder of what climate science has been telling us for 25 years. As well as a general warming and increasing sea levels, it predicted more frequent extreme events: floods, droughts, heatwaves and severe bushfires.”

In order to continue to protect communities from ongoing and increasing risk from these extreme weather events in Australia, it is time our political leaders and those in the media acknowledged the evidence of the risk we face. For in order to obtain the requisite community support for policy action, more information about these risks must be shared explicitly with the community.

Businesses that are bearing the brunt of extreme weather events are less reticent to do so, with global reinsurer Munich Re stating in December 2010: “The only plausible explanation for the rise in weather-related catastrophes is climate change”.

Given that we can’t take effective action unless the entire community comprehends the very grave risks we face, it is time our leaders (and more of the media) did the same.

It is unfortunate that a serious family illness prevented Richard Smith from delivering the Redfern Oration for the World Congress of Internal Medicine in Melbourne last year, but problems are opportunities in disguise.

He did not increase his ecological footprint but, thanks to webcasting, he delivered his address from his home in the antipodes and this has also enabled many more people than would otherwise have been the case to read and view his important 10 lessons as follows:

Lesson one: Modern clinical medicine is as out of control as the banks and is unaffordable globally.

Lesson two: Inequalities in our world are gross and need to be tackled.

Lesson three: The Victorians eventually couldn’t live with the difference between rich and poor, and we got income tax with substantial transfers of wealth within countries. We now need such transfers between countries.

Lesson four: You can’t have healthy people without healthy places.

Lesson five: We may not like to think in terms of money, but we have to pay close attention to costs—returning to the utilitarian roots of public health.

Lesson six: How we die may make a huge difference, and there are positive signs of the compression of morbidity. We must promote the idea that death is normal and a friend.

Lesson seven: New challenges need new ways of thinking and behaving.

Lesson eight: ideology can get in the way of progress.

Lesson nine: developing countries don’t have to follow the disastrous path of developed countries but can leapfrog their failures.

Lesson ten: the rich can learn from developing countries.

It is lesson 4 that has particular relevance to CAHA as Richard explains, “…healthy places will begin to disappear as our planet becomes sicker. We need a healthy planet in order to have healthy places, and luckily what is good for individuals—avoiding motorised transport and exercising more and eating more fruit and vegetables and fewer animal products– is also good for the planet.”

But all the lessons are relevant to CAHA. For example one of the key messages from the Marmot Review was that tackling social inequalities in health and tackling climate change must go together.

The message for me is that the major changes required to tackle failing health systems and the urgent need to develop alternate approaches is interconnected with the need to do the same for climate change.

The Climate and Health Alliance joined representatives of the Australian Conservation Foundation, The Climate Project, Union Climate Connectors and the Australian Youth Climate Coalition in Canberra to lobby for the introduction of a carbon price.

Around thirty people visited around 40 MPs and Senators in November 2010, outlining the case for a price on carbon to replace Australia’s ageing and high emitting fossil fuelled power generation infrastructure. A price on carbon would create an economic incentive to encourage the development and deployment of clean renewable energy.